Employment Testing Agreement

EMPLOYMENT TESTING AGREEMENT

This Employment Testing Agreement (the Agreement) is entered into between Employer Name: and Applicant / Employee Name: on this date:

1. Purpose and Scope

The parties agree that the Employer may require the Applicant / Employee to submit to employment-related testing as a condition of employment or continued employment. Tests may include, but are not limited to, drug and alcohol screening, medical examinations, psychological or cognitive assessments, skills or competency testing, and sample collection for laboratory analysis. Testing may be required prior to hire (pre-employment), for-cause, post-accident, random, periodic, or as otherwise permitted by law.

2. Types and Circumstances of Testing

I understand and consent that testing may be required under the following circumstances (check all that apply):

Pre-employment testing Random testing For-cause / reasonable suspicion testing Post-accident testing Periodic/recertification testing

3. Specific Tests

The following tests may be administered (check applicable boxes):

Drug and alcohol screening (urine, saliva, breath, blood) Medical examination or fitness-for-duty evaluation Psychological or cognitive assessment Skills, competency or job simulation testing Background check and verification of employment history

4. Sample Collection, Analysis, and Medical Review

Collection and analysis will be performed by a qualified testing provider selected by the Employer. I consent to sample collection by a qualified collector and to laboratory analysis. Positive or otherwise non-negative results for controlled substances will be reviewed by a Medical Review Officer (MRO) where required by applicable law and industry practice, and the MRO will contact me prior to reporting a confirmed positive result.

5. Consequences of Failure or Refusal

I acknowledge that a confirmed positive test result, a refusal to submit to testing, tampering with a specimen, or failure to follow collection procedures may result in adverse employment action up to and including withdrawal of an offer of employment or termination of employment, consistent with applicable law and Employer policy.

6. Confidentiality and Use of Results

Test results and related medical information will be maintained as confidential medical records, disclosed only to those with a legitimate need to know (including the MRO, designated Employer representatives, and testing laboratory), or as required by law. Results will be used for employment decisions only as permitted by law and Employer policy.

7. Reasonable Accommodation and Medical Exceptions

If I have a disability or medical condition that may affect testing or the interpretation of results, I will notify the Employer prior to testing. The Employer will consider reasonable accommodations in accordance with applicable law. Nothing in this Agreement waives the Employer's obligations under applicable disability or employment laws.

8. Release and Indemnification

To the extent permitted by law, I release and hold harmless the Employer and the testing provider from liability arising from the collection, testing, and reporting of test results, provided proper procedures are followed. I agree to indemnify the Employer for claims arising from knowingly providing false information or tampering with a test specimen.

9. Administrative Details

Testing provider name:

Who will pay for testing (check one): Employer Applicant/Employee Shared

Personal Information

Position Information

Employment History (most recent first)

Dates employed: From to

Dates employed: From to

Education

Professional References (3)

Legal Disclosures and Acknowledgments

At-Will Employment Acknowledgment: I acknowledge that unless I have a written contract expressly stating otherwise, my employment is at-will, meaning either I or the Employer may terminate the employment relationship at any time, with or without cause, and with or without notice, to the extent permitted by law.

Equal Employment Opportunity Statement: The Employer is an equal opportunity employer. Employment decisions, including testing requirements and use of results, will be made without unlawful discrimination.

Acknowledgment of Receipt and Understanding: I acknowledge that I have read and understand this Agreement, that I have had an opportunity to ask questions, and that I consent to the testing as set forth herein.

Applicant / Employee Certification and Authorization

By signing below, I certify under penalty of perjury that the information I have provided in this Agreement is true and complete. I authorize the Employer, its testing provider, and designated representatives to administer the tests described above and to obtain, receive, and use test results for employment-related determinations. I authorize prior employers, references, medical professionals, and testing laboratories to provide relevant information to the Employer or its testing provider.

I understand that I may request confirmatory testing where applicable and that I have the right to supply legitimate medical explanations for unexpected or non-negative test results for review by an MRO or other qualified medical professional.

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